It has been more than three years since John Hill suffered serious injuries when he was hit by a car while riding his bicycle along Route 155 near Havre de Grace, but he still lives with chronic pain that has robbed him of the ability to work and do most of the recreational activities he enjoyed before the accident.

"It's been three years, and I'm still trying to get an answer to relieve this pain," he said during a recent interview at his home between Churchville and Havre de Grace.

Christine Altom, who grew up in Bel Air and lives in Howard County, is also dealing with lingering effects of being hit while riding her bike in Elkridge in Howard County. While her knee and shoulder have recovered, she still had problems with headaches and comprehension.

Three years later, Altom is back on her bike. Hill is not. Altom said being safe is means being aware.

"Really, the biggest thing is always being aware of the situation," she said of road safety.

Hill and Altom are among more than 750 cyclists who are involved in accidents with vehicles across Maryland annually, according to state figures, a number that has been growing in recent years and has raised concerns among bikers, bicycling advocacy groups and public safety officials, alike.

DAVID ANDERSON | AEGIS STAFF / Baltimore Sun

John Hill, of Havre de Grace, shows one of the peppers he has grown in his garden while living with chronic pain, three years after he was hit by a car while riding his bicycle.

John Hill, of Havre de Grace, shows one of the peppers he has grown in his garden while living with chronic pain, three years after he was hit by a car while riding his bicycle. (DAVID ANDERSON | AEGIS STAFF / Baltimore Sun)

Bikers, and pedestrians for that matter, have to share the road with drivers, whose cars are bigger and much more dangerous than any bike a cyclist may be on.

State Highway Administration officials, along with their counterparts in the Maryland State Police and the Motor Vehicle Administration, have been working during the past decade to reduce the number of deaths and injuries suffered by bicyclists and pedestrians and educate all users of Maryland's roads about how to conduct themselves safely.

Courtesy of Christine Altom / Baltimore Sun

Christine Altom, a native of Bel Air who lives in Howard County, still rides her bicycle three years after suffering serious physical and mental injuries when she was hit by a car while riding in 2012.

Christine Altom, a native of Bel Air who lives in Howard County, still rides her bicycle three years after suffering serious physical and mental injuries when she was hit by a car while riding in 2012. (Courtesy of Christine Altom / Baltimore Sun)

"Whether you're walking to the library or driving to work, you're going to run into some other sort of mode of transportation," and you have to respect their rights to be out there, Cedric Ward, director of the SHA's Office of Traffic and Safety, said.

The number of accidents involving cyclists increased 5 percent between 2008 and 2012, however, with an average of 752 each year during that period, according to the Maryland Strategic Highway Safety Plan.

Five people were killed in Maryland bicycle accidents in 2012, and 68 people suffered serious injuries, according to the report. Ninety-six people died in pedestrian accidents, and 338 people were injured. Statistics for Harford County were not available.

State transportation officials have been pushing public education and outreach to improve safety, such as reminding motorists of the state law requiring them to maintain a 3-foot gap between their vehicles and bike riders, and encouraging pedestrians to cross the street in a crosswalk.

Ward stressed that drivers must also be aware of their surroundings at all times and avoid distractions.

"We have recognized that impaired, distracted, unbelted [driving] are all behavioral problems that contributed to a large percentage of our traffic crashes," he said.

'It's about education'

Eric Fisher, advocacy facilitator with the Harford Cycling Alliance, said he has been working with staffers in the Harford County Department of Planning and Zoning to make local roads more bike-friendly with bike lanes and the appropriate signage and road markings.

Fisher is also a member of the Town of Bel Air's Transportation Stakeholder Group, advising on issues affecting bicycle riders.

He said officials in the county seat "has been really proactive about making Bel Air more cycle-friendly."

Fisher also has been working to educate children and adults about bike safety.

"It's a two-way street; I think a lot of times our cyclists are very quick to lash out at drivers, but everybody needs to be responsible and use the road together," he said. "I think an awful lot of it's about education."

Fisher said safety measures for bike riders include wearing a helmet and bright clothing, having headlights and taillights on their bikes, riding in a single-file line if part of a group and saying as far to the right as possible.

He said drivers should "slow down" when they see cyclists and remain at least 3 feet away when passing them.

"We need to be aware of each other and take care of each other," he said.

'Totally a blur'

Hill, 60, was riding along Route 155 west of the intersection of Earlton Road on Feb. 27, 2012. It was around 5:30 p.m., and he had just passed the intersection.

He said a driver stopped to turn left on Earlton, and the traffic behind the vehicle swerved around it to the right onto the shoulder and then back on the highway.

One driver did not get back on the highway however, and she struck the rear of Hill's bicycle.

"I was well beyond that intersection," Hill recalled. "She had plenty of time to get back on the road, but she was just not attentive to her driving, and she remained on the shoulder way too long, and of course didn't see me."

Hill said the sun was still out, and he was wearing a white sweatshirt and fluorescent orange cap.

"I didn't know what hit me," Hill said when describing the moment of impact. "That part is just totally a blur. I don't remember anything about being hit."

Hill said he was "in and out of consciousness," but he remembers two people who stopped and called 911, and they stayed with him until EMS workers with the Level Volunteer Fire Company arrived.

"I was starting to come to enough to tell them who I was, and my wife's name and phone number," he said.

Hill said he was taken by ambulance to Johns Hopkins Bayview Medical Center in Baltimore, where he learned he had a "burst fracture" in the lower section of his spine, along with compression fractures in several other lower vertebrae, broken ribs and internal bleeding.

Hill went through surgery on his spine and spent eight days at Bayview. He was then sent to MedStar Good Samaritan Hospital, where he spent three weeks in rehabilitation before he was cleared to return home.

Since then, Hill has dealt with severe pain in his lower body that makes even sitting and standing difficult, despite a variety of pain management treatments and painkilling medication. He has been diagnosed with Complex Regional Pain Syndrome, or CRPS, a neurological disease.

On a pain scale of one to 10, Hill said he is at least a seven most days.

"If I go outside and do some work, it will exacerbate it, and I'll spend a day or two simmering back down," he said.

Hill worked for the Maryland Department of the Environment at the time of his accident.

He said he rode his bike about five days a week, 10 miles a day.

"I worked in Baltimore, so it was, get home, jump on the bike, ride my 10 miles," Hill said.

Hill spent 10 years with the MDE, and he spent his final year working at home after the crash. He worked 20 hours a week, but he was ultimately released on disability.

Despite the pain, Hill stays as active as he can. He works in his vegetable garden and flower bed, and he plays acoustic guitar and sings with area churches.

"I can't simply spend my day curled up on the bed," he said. "You've got to get up, you've got to keep moving, you've go to keep doing things."

To improve safety among drivers and bike riders, Hill encouraged motorists to keep their attention on their driving, and he encouraged cyclists to ride in single file if they are in a group and "make as much use of that [highway] shoulder as possible."

"It really comes down to people just people being responsible," he said.

Lingering issues

The physical injuries Christine Nicewonger Altom, who grew up near Bel Air and lives in Howard County, suffered from her 2012 bicycle accident have healed for the most part, but she still deals with the mental issues lingering from her head injury.

Altom, who is 28, was riding along Levering Avenue in Elkridge toward the intersection with Route 1 on Oct. 2, 2012.

She was approaching the intersection when a driver turned right onto Levering from Route 1 and was making a left turn into a gas station parking lot when the vehicle struck Altom.

"Basically, I got T-boned by a car," Altom recalled.

Altom's right knee, left shoulder and spine were injured. She struck her head on the street after being slammed against the front of the car that hit her.

"My knee and my shoulder are pretty good, and my back is in pretty good condition, but my head is still a bit of a mess," she said.

Altom said she struggles with a "constant headache," ringing in her ears, as well as visual issues such as sensitivity to light and eye strain, along with difficulty completing simple tasks, and occasionally forgetting words as she is talking.

"The biggest issue that I've had is trouble reading and comprehending," she said.

Altom was working on her doctorate in exercise physiology at the University of Maryland at College Park, but "I ended up having to drop out of the program after about a year of trying to stay in."

"My reading level actually went down, at one point, to a first-grade reading level," she said.

Altom also becomes fatigued easily, and she compares the amounts of energy needed to complete simple tasks to pieces of candy in a jar, and every bit of energy used means taking another piece out of the jar.

"It takes quite a while to build that jar up," she said.

Altom travels between her home in Elkridge and Dallas, Texas, every few weeks for treatment of her head injury.

Altom still rides her bike, though, and she works for 90+ Cycling, of Columbia, a company that specializes in cyclist training and bike maintenance. She must rest before and after work, though, because of her fatigue symptoms.

She thanked her boss, 90+ founder John Hughes, for his support.

"John's been a blessing this whole time, and getting the opportunity to work with him has been really fun," she said. "We've been able to build up 90+ Cycling in a way that I think has been great for all of our clients, as well as us."

Altom grew up in Bel Air, graduating from C. Milton Wright High School in 2005. She played soccer and ran track while in high school and college; she did not get into cycling until 2009.

She rode bike for fun as a child, and she remembers racing with her brother along Henderson Road to the 7-Eleven store on Route 1.

Altom rides five to six times a week, and she stays on low-traffic roads in the Ellicott City and Columbia areas.

She does not ride along major highways such as Route 1, but it is necessary to cross it to get to roads with less traffic.

"Cyclists are considered motorists," she said. "We're not pedestrians when we're on the road, so we have the same rights to the road as automobiles, but we also have to follow the same laws."

Altom said she makes sure she adheres to traffic laws when riding but she is also "putting myself in the safest position that I can on the road."

Altom said education and "mutual respect" among cyclists and drivers are key to keeping everyone safe.

"It's a stress relief," she said of why she enjoys cycling. "I love being outside; it's probably where I do some of my best thinking, on a bike, especially if it's out on back country roads."